The internal debate on health care strategy for Democrats can be boiled down to this: do we choose the approach whose specifics are more popular with the public and will almost certainly work better in practice once it gets passed, or do we want to go with something that has some bipartisan support and may avoid an all out war with the insurance industry?
The first approach is currently being championed by President Obama (although not always by his Chief of Staff), Speaker Pelosi, Senator Reid, and 4 of the 5 committee chairs responsible for bringing the legislation to the floor. The second approach is strongly favored by Senate Finance Committee chair Max Baucus, Tennessee Rep. (and co-killer of health care reform in the Clinton years) Jim Cooper, and a few conservative Democrats in the Senate.
Seems like a damn easy choice to me.
The first thing to understand in all this is the consequences for the Democrats for the next generation and probably longer if they pass some convoluted, complicated, unworkable compromise that doesn't change the abusive patterns in the insurance and pharmaceutical industries and doesn't begin to control health care costs. If they pass a compromise that doesn't meet regular people's needs, folks will figure it out very quickly, as most people deal with the health care system all the time. If the Democrats twist up this bill to make insurance companies and their Republican allies happy, it is end of story for this generation of Democrats -- our party will not recover from screwing up health care.
The second thing to understand is that wealthy, powerful elements of the health care industry, along with the entire right-wing message machine, will oppose any health care reform bill. Democrats trying to avoid a fight should just get over it: they will get one no matter what.
Here's the other thing: having a clear, clean fight -- Obama and the Democrats take on the insurance companies -- is an easier message to win with than the mushy "we're all in this together, we're all partners in solving this problem" thing Obama has been doing so far. Having enemies helps define this fight in Obama's favor, especially when the enemies are as unpopular as the insurance companies.
So face your fear, Max Baucus. Tell you health industry allies no, Jim Cooper. Work through your fear of commitment, Evan Bayh and Ben Nelson and Blanche Lincoln and Mary Landrieu. Let's put together a bill that actually works and move forward sometime soon, in our lifetimes preferably. It's time to get this done.